Persons with dependent personality disorder (DPD) have difficulties describing their inner world, and in realizing their negative ideas about the self, such as being weak, unworthy or powerless are just ideas. As a consequence, they tend to over-rely on others and may lose control over their emotions. Treating these persons can gain benefits from including body-focused techniques as they can promote a) awareness of internal states, b) better emotion regulation, c) the capacity to consider their negative ideas about themselves as not necessarily true, and d) gain power of and agency. We will describe the therapist used body-focused techniques in the context of Metacognitive Interpersonal Therapy when treating Lia, a 40-year-old woman suffering from DPD who also suffered from generalized anxiety disorder and had difficulties in making autonomous choices. She had a romantic relationship with a man she described as distant and judgmental so she felt lonely and not entitled to express her discomfort or capable to break up. The therapist used body-focused techniques, together with behavioural exposure, mindfulness and guided imagery, in order to let Lia be more aware of her thoughts and feelings, and then to regulate affects and realize she had previously capacities. At therapy termination anxiety diminished and she could break up with the partner and start a new one where she felt free to express herself. We suggest how bodily-focused techniques can be used to enhance therapy effectiveness in DPD.
Objective: Cognitive Behavior Therapy (CBT) is an effective treatment for anxiety and depression disorders. Nonetheless, nearly 50% of all patients do not respond. Besides other factors, this seems to be linked to the experience of traumatic life events. This study aims to assess the effects of trauma history on the choice of therapy interventions and treatment outcomes. Methods: We analyzed data from 340 CBT outpatients diagnosed with a depression or anxiety disorder and possibly a trauma history treated under naturalistic conditions. Based on their written therapy files, we collected information on trauma history, psychiatric diagnoses, duration of therapy, applied interventions, and severity of depression and anxiety symptoms at the start and end of therapy. The influence of trauma, diagnoses, and intervention use on the development of depression and anxiety symptoms were analyzed. Results: Patients with a trauma history reported higher overall depression and anxiety symptoms than those without trauma. No differences in the duration of therapy, applied interventions, or decrease in symptom severity were found between patients with and without a trauma history. Trauma-specific interventions failed to boost treatment success; however, they were also seldom applied. Conclusion: Although no differences between traumatized and non-traumatized patients were found for naturalistic CBT, traumatized patients maintained higher levels of symptom severity irrespective of diagnoses. These results indicate a need for more trauma-specific and personalized interventions. Therapists may need evidence-based guidelines to personalize CBT for patients with a trauma history and high symptom severity.
Objective: Emotion intolerance and perfectionism are two maintaining mechanisms to eating disorder psychopathology. However, it is unclear how these mechanisms relate to one another. This study explored whether perfectionism is a vulnerability factor for facets of restrictive eating in the context of body-related emotions. Methods: Female undergraduate students ( N=148) completed questionnaires assessing baseline levels of self-critical perfectionism and personal standards perfectionism. Participants then engaged in an ecological momentary assessment protocol where body-related emotion intolerance and restrictive eating facets (cognitive restraint and behavioural restriction) were assessed over 10 consecutive days. Multi-level modeling and simple slopes analysis were used to explore these moderated relationships. Results: Based on the analyses, both self-critical and personal standards perfectionism dimensions interacted with body-related emotion intolerance to predict increases in restrictive eating facets. Conclusion: These findings indicate that personal standards perfectionism, though conceptualized as the less maladaptive dimension of perfectionism, should not be ignored in eating disorder conceptualizations and treatments. Recommendations are provided on how to refine treatment targets to be more attuned with situations that elicit body-related emotion intolerance.
Substance use disorders (SUDs) are highly prevalent and have deleterious effects on one’s health and well-being. Inpatient treatment for SUDs reduces patient relapse, which subsequently ameliorates these negative effects on the individual and society. Additionally, those who complete treatment are less likely to relapse compared to those who do not complete treatment. Thus, maintaining patient engagement in treatment and reducing the rates of those leaving against medical advice (AMA) is particularly important. Examining the factors and comorbidities that may contribute to treatment dropout has the potential to identify at-risk patients in need of additional individualized intervention. The current study aimed to examine comorbid anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms as predictors of dropout AMA in a residential substance use treatment population. Results showed that patients with social anxiety were more likely to leave treatment AMA, while those with PTSD were more likely to complete treatment. Findings suggest that PTSD-specific treatment, as offered in this facility, may help with patient retention, while group focused therapy may be distressing to those with social anxiety. Clinical implications of this research may include incorporating evidence-based practice for social anxiety early during inpatient treatment to reduce anxiety such that patients may better engage with SUDs treatment.
This study aims to investigate the potential of a modified Cognitive-Behavioral Group Therapy (CBGT) intervention in promoting social adjustment and reducing parental stress among children exhibiting symptoms of attention deficit hyperactivity disorder (ADHD). The research also highlights the mechanisms and advantages of employing modified CBGT counseling to address negative symptoms associated with ADHD in children. The study was conducted at Fuzhou Children’s Hospital of Fujian Province, involving two CBGT counseling sessions held in 2021 and 2022, with a total of 20 pairs of parents and children with ADHD participating. The assessment utilized measures such as SNAP, Barratt Impulsivity, and Conners to evaluate changes in the children’s social adjustment abilities and core/associated ADHD symptoms before and after CBGT intervention. Additionally, the Parental Stress Index was employed to gauge the level of stress experienced by the parents. The results demonstrated that modified CBGT interventions effectively alleviate ADHD symptoms, enhance parent-child relationships, and reduce parental stress levels. Consequently, CBGT interventions have shown substantial improvements in children’s social adjustment abilities and have proven to be a significant source of relief for parents. The study also addresses the limitations associated with existing ADHD treatments and CBGT interventions.
Transference-focused psychotherapy (TFP) is an evidence-based, psychodynamic psychotherapy empirically validated for patients with borderline personality disorder (BPD) and successfully adapted for the treatment of narcissistic personality disorder (NPD). Personality disorders are characterized by the behavioral and affective dysregulation associated with pathological identity formation. Based on contemporary object relations theory (ORT), the goal of TFP is symptom relief through improvement in self and interpersonal functioning. The TFP treatment frame, established through an initial contracting phase and combined with the therapist’s technical neutrality, facilitates activation, identification and containment of affectively charged perceptions of self and other. These perceptions, or object relations dyads, are repeatedly identified, labeled and explored through the interpretative process. Over the course of treatment, the patient’s capacity for affect containment and reflection improves and a better integrated, realistic sense of self develops consistent with healthier personality functioning. Utilizing a compilation of several patients, the treatment of NPD with TPF is described and the evidence for the efficacy of TFP for NPD is summarized.
Background: Attachment theory has served as an influential framework for understanding psychopathology, partly due to reliable assessment methodology. The influence of insecure attachment on attitudes towards the body and the impact this might have for the development of psychopathology is however less well elucidated. Method: 123 adolescents (35 with borderline personality disorder or BPD, 25 with other personality disorders or OPD and 63 comprising a healthy control group) were interviewed with the Adult Attachment Interview (AAI) and the Mirror Interview (MI). The MI questions respondents about how they feel about their bodies, as they look in the mirror Results: The AAIs from the BPD group were predominantly insecure-preoccupied and unresolved. Adolescents with PD but particularly BPD had significantly greater issues with negative body representations (NBR) than the control group. Insecure attachment and unresolved attachment status were significantly linked to NBR. Regression results revealed a low loving relationship with fathers, high involving anger with father, low coherence of mind & passive speech uniquely predicted 61% of variance in NBR. Conclusion: Unfavorable attachment experiences may give rise to negative body images and influence the development of psychopathology, especially BPD.
Introduction: The purpose of this study is to understand the role of suicide literacy and suicide stigma in laypeople’s intention to recommend professional help in Korea. Additionally, the study focuses on the role of expressive suppression as a sociocultural factor. Methods: Participants read vignettes depicting either subclinical distress or suicidal ideation and answered questions measuring suicide literacy, stigma, and expressive suppression. Mediated moderation analyses were used to examine the interactions between these factors. Results: The result found the significant effect of emotional suppression. The mediating effect of suicide stigma on the relationship between suicide literacy and recommendation of professional help was significant for those who do not suppress their emotions. This result indicates that when individuals were not hesitant to express negative emotions, high suicide literacy lowered suicide stigma and led to more willingness to recommend professional help. Conclusions: The results showed that emotional suppression acts as a barrier deterring Koreans from professional help for their mental health. The findings underscore the importance of sociocultural factors such as emotional suppression in developing suicide prevention strategies.
Intuitive Eating Scale-2 (IES-2) is a measurement of intuitive eating behaviors and has been validated, with traditional latent variable approaches, in youth and adults from a number of different populations, including college students in China. However, there still lacks the evaluation of the psychometric properties of the IES-2 in adults from the Chinese general population. Moreover, psychometric network analysis, as a complement to traditional latent variable approaches, has not been used for examining the psychometric properties of the IES-2. Thus, the present study aimed to use a psychometric network approach to evaluate the psychometric properties of the IES-2 in Chinese adults from the general population. A sample of 700 Chinese general adults (50% women; M age = 31.13 years, SD = 9.19) were included in the present study. Psychometric network analysis was performed by using EGAnet and psychonetrics packages on R 4.2.0. Exploratory graph analysis (EGA) identified four dimensions, which were well-separated in the estimated network. The network structure showed excellent stability and metric measurement invariance (i.e., network loadings) across men and women. Furthermore, several items in the IES-2 were identified as key nodes in the network of the IES-2 that may be important for the developement and maintenance of intuitive eating. For example, two items related to reliance on body cues were the most impactful nodes in the complete network. The findings of our study provide further understandings of the IES-2 from the perspective of network analysis and have implications for related applications of intuitive eating interventions for general populations.
Objectives: Perinatal psychopathology can be damaging. This study examined the strength of the associations between risk factors and all perinatal mood and anxiety disorder symptoms while assessing the mediating effect of experiential avoidance. Method: Participants ( N =246) completed assessments during pregnancy (28-32 weeks) and the postpartum (6-8 weeks). Structural equation modeling (SEM) was used to examine associations between risk factors and latent factors: Distress (composed of depression, generalized anxiety, irritability, and panic symptoms); Fear (social anxiety, agoraphobia, speciﬁc phobia, and obsessive-compulsive); and Bipolar (mania and obsessive-compulsive). Results: During pregnancy, past psychiatric history, anxiety sensitivity, maladaptive coping, and age were significant risk factors. In the postpartum, negative maternal attitudes and past psychiatric history were only risk factors for symptoms that composed Distress. Experiential avoidance mediated the relation between maladaptive coping and symptoms that composed Fear. Conclusion: It is important to assess for psychological risk factors starting in pregnancy. This study identified critical risk factors that are associated with the underlying commonality among perinatal mood and anxiety symptoms. Some of the risk factors as well as the mediator are malleable (negative maternal attitudes, experiential avoidance), creating new possibilities for prevention and treatment of perinatal mood and anxiety disorder symptoms.
Objective: A qualitative study sought to understand the transition experiences of United States (U.S.) military Service members found “unfit for duty” following medical and physical evaluation boards (MEBs and PEBs). Methods: Confidential telephone interviews were conducted with 25 current and prior Service members. Participants were asked to share their experiences before, during, and after the MEB and PEB processes. To that end, interview questions were designed to gather the following types of transition experiences: (1) health conditions experienced during the medical disability evaluation process; (2) reactions to being recommended for separation, (3) transition-related stress and challenges, and (4) coping strategies. Salient themes were identified across chronological narratives. Results: Conditions that participants’ experienced included debilitating physical (e.g., injury) and/or mental health (e.g., post-traumatic stress disorder) conditions. In response to the “unfit for duty” notice, some participants reported emotional distress (e.g., anxiety, sadness, anger) connected to a sense of uncertainty about the future. Other participants reported relief connected to a sense of progression toward their medical disability claim status. Transition stress included the length of the MEB/PEB process, impact of the COVID-19 pandemic on the process, experiences of financial stress, impact on family life, and the compounded effect of these stressors on emotional distress, including depression and suicidal thoughts. Participants reported using adaptive (e.g., psychotherapy) and maladaptive (e.g., excessive drinking) strategies to cope with stress. Conclusions: The notable emotional distress and transition stress experienced by Service members found “unfit for duty” highlight the need for increased support and interventions to facilitate adaptive coping strategies during this vulnerable period.
Objective: Interpersonal difficulties are salient among those with a history of NSSI and precede NSSI urges and behaviors. Yet, limited research has focused on identifying which aspects of interpersonal stress may confer risk for NSSI. Method: The current study aimed to leverage data from two samples (combined n=206; n=114 with NSSI history) of participant-driven interviews regarding a recent interpersonal stressor to enhance the field’s knowledge of interpersonal difficulties in relation to NSSI risk. Results: Using topic modeling to extract thematic information, analyses identified four main topics: daily difficulties; family members; adjectives/verbal fillers; and friendship/romantic relationships. Relationships between the topics and three predictors (i.e., NSSI history, emotion dysregulation, sample) were examined. In one sample, the proportion of ‘adjectives/verbal fillers’ was greater for participants with a NSSI history and at higher levels of emotion dysregulation. Across samples, for participants with a NSSI history, ‘adjectives/verbal fillers’ and ‘friendship/romantic partners’ increased with levels of emotion dysregulation. Conclusion: Findings highlight a greater use of adjectives and verbal fillers among individuals with a history of NSSI and higher levels of emotion dysregulation. This pattern of language may serve as an indicator of a specific aspect of emotion regulation difficulties that confers risk for NSSI.
Background Bipolar disorder (BD) is a severe mental illness characterised by recurrent manic, hypomanic and depressive episodes alternating with euthymic periods. The burden of BD is vast, and many patients have unmet needs in their treatment. To better support patients in their personal recovery and well-being, positive psychology interventions (PPIs) have shown to be a promising tool. Recently, a mobile application has been developed to offer PPIs: the WELLBE BD-app. Aim The current study was designed to study the acceptability of the WELLBE BD-app and evaluate the feasibility of the design for use in a larger controlled trial (CT). We also studied the potential effects on mental health. Method This pilot-study used a mixed-methods quantitative and qualitative approach in which participants were randomly assigned to an intervention- or a treatment-as-usual control group, each with 20 participants with BD. The study sample consisted of a seven weeks during intervention. To assess acceptability, we held semi-structured interviews in the intervention group and collected log data and questionnaire data on the actual use of the app and perceived value of the accompanying exercises. Feasibility was determined by the number of completers of the intervention in both the intervention and control groups. Potential effects on mental health outcomes were measured using an extensive set of pre and post-intervention questionnaires. Results The intervention was fully completed by 52.7% (n = 11) of the participants and partly completed (1 to 4 modules) by 37.8% (n = 8). The post-test response rate was 73% in both groups. On average, the exercises were rated with a value of 7.5 on a scale of 1 to 10 ( SD = 1.2). Users found the application easy to use, useful for people with BD, and to have an attractive design. Problems with installation, technical problems, and lack of support were barriers to using the app. Guidance by an expert by experience (in videos before the exercises) was preferred by 80% of the participants instead of guidance by a professional. Effects on mental health outcomes were small and statistically non-significant, both between- and within groups. Although we found no significant results in the quantitative part of our study, the qualitative results show that people with BD appreciated the content and design of the intervention. The minimal effects on mental health may be partly explained by the small sample size and the relatively high levels of mental health of the participants at baseline. Conclusions and Implications for Practice Based on this study a larger trial on the effects of the WELLBE-app appears feasible and warranted. Next to minor modifications based on this pilot study, to create optimal impact including patients with lower levels of well-being is recommended and the guidance by experts or peers needs to be considered.
Objective: Although life stress and adversity have emerged as risk factors for mental health problems and cognitive impairment among older adults, prior studies on this topic have been cross-sectional and based on relatively homogeneous samples. To address these issues, we examined prospective associations between lifetime adversity and symptoms of depression, anxiety, and cognitive impairment in a nationally representative, longitudinal sample of older adults in the U.S. Method: We analyzed data from the Health and Retirement Study (1992-2016). The sample included 3,496 individuals (59.9% female), aged ≥64 years old (M age=76.0 ±7.6 years). We used the individual-level panel data and ordinary least squares regressions to estimate associations between childhood and adulthood adversities and later-life depression, anxiety, and cognitive impairment. Results: Many participants experienced a significant early life (38%) or adulthood (79%) stressor. Second, experiencing a childhood adversity was associated with a 17.4% increased risk of experiencing an adulthood adversity. Finally, childhood and adulthood adversities both prospectively predicted more symptoms of late-life depression, anxiety, and cognitive impairment. Discussion: These findings are among the first to demonstrate prospective associations between lifetime adversity and symptoms of depression, anxiety, and cognitive impairment in older adults. Screening for lifetime stressors may thus help health care professionals and policymakers identify individuals who could benefit from interventions designed to reduce stress and enhance resilience.